A variety of caregiver practices characterize the second stage of labor. Research suggests a caregiver style sensitive to maternal self-regulation (e.g., in response to bearing-down efforts and maternal positioning) improves maternal and fetal outcomes. Using video tape analysis, Phase I of this research identified regulatory and responsive interactive patterns during second stage which are associated with maternal and fetal outcomes. The results also suggested that birth setting influences caregiver behaviors. In Phase II, the study will be expanded to include additional birth settings, The aims of Phase II are to: 1) describe and compare the features of four commonly used birth settings (a traditional Level III hospital, a Level II hospital with single-unit maternity care, a freestanding birth center, and home births); 2) examine the influence of environment on caregiver behaviors; and 3) examine the effect of caregiver behaviors on maternal position, bearing-down efforts, and maternal and fetal outcome in these four birth settings. The aims will be addressed by a variety of qualitative and quantitative methods: 1) conducting an ethnographic analysis of the four birth settings; 2) continuing the video taping of second stage labor in the four settings to analyze mother/caregiver interaction and the birth environment; 3) collecting case-specific environmental data using an observation guide; 4) interviewing mothers and caregivers post-birth to obtain their perspectives on recorded events; 5) comparing maternal and fetal outcomes across birth settings; and 6) analyzing maternal and fetal physiologic responses related to caregiver style at the Level III hospital setting. A minimum of 25-low-risk parturients from each birth setting will be selected. The proposed analytic strategies include ethnographic, descriptive, and inferential (ANCOVA, repeated measures factorial ANOVA). The findings will be integrated using triangulation strategies. The results will provide empirical data about birth outcomes that are associated with different birth settings and caregiver behaviors. These findings will guide providers in the management of the second stage of labor and should enhance the attainment of optimal maternal and fetal outcomes.